RESUMEN
Assisted reproduction with testicular sperm extraction (TESE) and intra-cytoplasmic sperm injection (ICSI) are fertility treatment options for couples with severe oligospermia or azoospermia. A retrospective review was performed of 146 TESE procedures in a specialist fertility centre in Ireland. The indication for TESE was obstructive azoospermia (OA) in 59% (n = 80) and non-obstructive azoospermia (NOA) in 41% (n = 56). Sperm retrieval rates after TESE were determined and the pregnancy rates per ICSI cycle number were evaluated. Sperm retrieval rates were 99% (n = 79/80) and 32% (n = 18/56) for OA and NOA men respectively. Fifty-eight couples proceeded to ICSI. Overall 114 ICSI cycles were performed and 33 cycles resulted in fertilisation (29%). Our sperm retrieval and pregnancy rates are consistent with international studies and support the ongoing role for TESE and ICSI as successful assisted reproductive techniques for male factor infertility in Ireland.
Asunto(s)
Azoospermia/terapia , Inyecciones de Esperma Intracitoplasmáticas , Recuperación de la Esperma , Aborto Espontáneo/epidemiología , Adulto , Femenino , Humanos , Irlanda/epidemiología , Masculino , Embarazo , Índice de Embarazo , Estudios Retrospectivos , Recuperación de la Esperma/estadística & datos numéricosRESUMEN
In recent years, the survival of young males suffering from cancer has been improved. Development of new techniques such as IVF and intracytoplasmic sperm injection enables even low quality spermatozoa to be used successfully. It is possible therefore to preserve fertility potential of cancer patients before embarking on adjuvant chemotherapy and radiotherapy. Recognizing the importance of protecting the fertility potential of these young males, we present our recommendations for sperm cryopreservation based on the 11 year experience of Bourn Hall and the British Joint Council for Clinical Oncology consultation report. This paper discusses the options available for patients who recover from cancer to become fathers. In many cases patients are concerned about possible abnormalities and teratogenic risks to their future children who have been conceived naturally or by fertility treatment. The data available in the literature may reassure the medical community that there is no such increased risk. However, due to the relatively small number of children born after such treatment, a long-term follow-up is required. There is an ongoing debate regarding the justification for the programme due to the small number of patients who make use of their banked spermatozoa. The authors believe in the importance of protecting the fertility potential of cancer patients, enabling them to father their genetic children in the future while fighting their illness.
Asunto(s)
Criopreservación , Técnicas Reproductivas Asistidas , Preservación de Semen , Neoplasias Testiculares/fisiopatología , Neoplasias Testiculares/terapia , Adolescente , Adulto , Antineoplásicos/efectos adversos , Femenino , Fertilidad/efectos de los fármacos , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Testiculares/tratamiento farmacológico , Neoplasias Testiculares/radioterapiaRESUMEN
OBJECTIVE: To assess the relevant factors affecting patients' decision when choosing a clinic for private, self-funded IVF treatment. DESIGN: Prospective anonymous closed questionnaires. SETTING: Single tertiary-care private IVF center. PATIENT(S): New patients attending primary consultation in a period of 7 months from September 1999 to March 2000. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Primary knowledge about the clinic, source of referral, knowledge of, availability of information pack, and familiarity with the clinic's success rates and treatment's price. The last question assessed the relative importance of each factor in the decision-making process according to the SERVQUAL model, modified version. All items were measured as perceptions on a 5-point Likert scale. 1 = not important, 3 = neutral, and 5 = very important. RESULTS(S): One hundred seventy-five patients completed the questionnaire. They were well informed and investigated the market before making their final choice. Patients collect information from many sources, including new channels such as the Internet. Up to one third of patients do not consult their doctor before treatment. By far the most relevant factor in decision making is the success rate (i.e., delivery rates) of the clinic, followed by recommendation by general practitioner (GP) or consultant (respectively, Likert scale score, 4.6; 95% confidence interval [CI], 4.5-4.7; and Likert scale score, 4.0; 95% CI, 3.9-4.2; P<.01). Other factors, such as cost of the treatment, friends and relatives' opinions, and distance from home were not relevant. CONCLUSION(S): Units that wish to thrive and increase their market share should deliver high-quality service and concentrate their efforts on excelling in performance.
Asunto(s)
Fertilización In Vitro/psicología , Infertilidad/terapia , Satisfacción del Paciente , Instituciones de Atención Ambulatoria , Femenino , Fertilización In Vitro/economía , Humanos , Masculino , Educación del Paciente como Asunto , Satisfacción del Paciente/economía , Embarazo , Estudios Prospectivos , Encuestas y Cuestionarios , Reino UnidoRESUMEN
Recent advances in culture media preparations have allowed for cleavage embryos to be developed to the blastocyst stage. Blastocysts are regarded as having increased implantation potential, and two blastocysts are typically transferred, which reduces the occurrence of high order multiple gestations. However, with current techniques, most cleavage embryos do not become blastocysts and it is not clear how many of these embryos would have implanted had they been replaced at the cleavage stage. Furthermore, experience with blastocyst cryopreservation is lacking and the overall benefit of blastocyst culture is unknown, unless we consider the combined pregnancy rates of both fresh and frozen blastocysts.
Asunto(s)
Blastocisto , Transferencia de Embrión/métodos , Femenino , Fertilización In Vitro/métodos , Fertilización In Vitro/estadística & datos numéricos , Humanos , Embarazo , Embarazo Múltiple/estadística & datos numéricosRESUMEN
The case of a 28 year old male with normal male phenotype, in whom repeated seminal analysis showed complete azoospermia, is presented. Peripheral blood culture for chromosome studies revealed 46 chromosomes with XX constitution. Polymerase chain reaction (PCR) analysis of genomic DNA failed to detect the presence of the sex-determining region of the Y chromosome (SRY). A literature review of all SRY-negative XX males with normal male phenotype showed that this case is the sixth reported case but the first to be diagnosed during the investigations of infertility. The frequency, aetiology and diagnosis of this rare syndrome are also reviewed.
Asunto(s)
Células Sanguíneas/fisiología , Proteínas de Unión al ADN/genética , Infertilidad Masculina/genética , Cariotipificación , Proteínas Nucleares , Factores de Transcripción , Adulto , Humanos , Masculino , Oligospermia/genética , Proteína de la Región Y Determinante del SexoRESUMEN
Monozygotic twinning is a relatively rare event in in-vivo conception, being estimated to occur in 0.42% of all births. The underlying mechanism for monozygotic twin formation is the division of the embryo early in its development. Separation of cells may theoretically occur before or after inner cell mass formation. In this analysis we report 11 cases of monozygotic twins resulting from IVF or intracytoplasmic sperm injection (ICSI) treatment cycles performed between 1991 and 1998 at St James's University Hospital, Leeds, and Bourn Hall Clinic, Cambridge, UK. Six cases (55%) followed treatment with ICSI and seven cases (64%) were in women aged > or = 35 years. This article also reviews the scientific literature discussing information pertaining to frequency, aetiology and potential complications of the monozygotic twinning phenomenon. We conclude that patients at risk of monozygotic twinning are those aged >35 years of age and those who had artificial opening in the zona pellucida by application of micromanipulation techniques. Women undergoing assisted conception treatment, particularly those with these two risk factors, must be informed of the low but definite risk of monozygotic twinning when counselled regarding the number of embryos to be transferred and chances of multiple births.
Asunto(s)
Embarazo Múltiple , Inyecciones de Esperma Intracitoplasmáticas , Gemelos Monocigóticos , Adulto , Cesárea , Femenino , Fertilización In Vitro , Muerte Fetal , Humanos , Embarazo , Resultado del Embarazo , Ultrasonografía PrenatalRESUMEN
The case for routine human immunodeficiency virus (HIV) screening of all couples seeking assisted reproductive treatment is so strong that it should be made obligatory for all couples entering IVF programmes to be given information about HIV transmission, and offered testing. In August 1999, questionnaires regarding routine HIV screening of couples seeking IVF treatment were sent to the medical directors of the 74 licensed assisted conception units in the UK. Of the 45 (60.8%) centres who responded, 19 (42.2%) routinely screen both partners for HIV antibodies, 25 (55.5%) do not screen and one centre selectively screens high-risk patients. There was no significant difference in the proportion of centres that routinely carried out screening with regards to the unit size: six out of 13 (46.2%) small units compared with 13/32 (40.6%) large units. In all, 17 centres (37.8%) rated HIV screening as essential, nine (20%) as desirable, 11 (24.4%) as not required, while eight (17. 8%) centres did not comment. Of the 19 centres that have a routine screening policy, 18 have management protocols in the event that the test is positive. Of these 18 centres, 12 adhere rigidly to the protocol, while five centres adhere to the protocol with few exceptions and the remaining one uses its protocol for guidance only. The main reasons for not employing routine HIV screening were: the lack of cost effectiveness, low prevalence of HIV infection in their population, necessity for and cost of counselling, uncertainty about the need for screening and potential delay to start of treatment.
Asunto(s)
Fertilización In Vitro/estadística & datos numéricos , Infecciones por VIH/diagnóstico , Tamizaje Masivo , Recolección de Datos , Política de Salud , Humanos , Encuestas y Cuestionarios , Reino UnidoAsunto(s)
Fertilización In Vitro/estadística & datos numéricos , Infertilidad Femenina/terapia , Madres Sustitutas/estadística & datos numéricos , Adulto , Actitud , Inglaterra , Femenino , Fertilización In Vitro/métodos , Fertilización In Vitro/psicología , Regulación Gubernamental , Humanos , Negativa al Tratamiento , Madres Sustitutas/psicologíaRESUMEN
Ectopic pregnancy may be the only life-threatening disease in which prevalence has increased as mortality has declined. The most prominent theory to explain this phenomenon involves increased sensitivity of serum beta-human chorionic gonadotrophin (HCG) immunoassay and improved quality of transvaginal ultrasound, combined with a heightened awareness and increased suspicion of the condition among clinicians which has allowed early detection of ectopic pregnancy. Laparotomy, once the standard treatment of ectopic pregnancy, has been replaced almost entirely by operative laparoscopy. This is associated with a shorter hospital stay, fewer post-operative analgesic requirements, reduced costs and lower risk of adhesion formation. Laparotomy, however, remains necessary in cases with haemodynamic instability and with exceptional locations, e.g. cervical, abdominal and interstitial implantation. In selected cases, non-surgical management has also obtained high success rates. Among medical therapies, the most common is systemic or local administration of methotrexate. The other option is expectant management involving follow-up using serial serum HCG measurements and ultrasound scans. Thus, life-threatening ectopic pregnancy is now evolving into a medical disease, with the possibility of lower-cost treatment, faster recovery and higher subsequent fertility. In this review we assess the risk of extra-uterine implantation after assisted conception treatment, the accuracy of various diagnostic tools and focus on the efficacy, safety and the fertility outcomes of surgical and nonsurgical management of ectopic pregnancy.
Asunto(s)
Embarazo Ectópico/etiología , Embarazo Ectópico/terapia , Técnicas Reproductivas/efectos adversos , Gonadotropina Coriónica/sangre , Femenino , Humanos , Histeroscopía/métodos , Incidencia , Infertilidad Femenina/terapia , Laparoscopía/métodos , Metotrexato/administración & dosificación , Metotrexato/uso terapéutico , Embarazo , Embarazo Ectópico/diagnóstico , Embarazo Ectópico/epidemiología , Progesterona/sangre , Factores de RiesgoRESUMEN
Two couples, each suffering from longstanding primary subfertility due to severe oligoasthenoteratozoospermia in the male partner and perimenopause in the female, were referred to Bourn Hall Clinic for assisted conception treatment. Both couples received independent counselling prior to being accepted onto our programme. Both women conceived following embryo transfer. The embryos were created from (separate) donor oocytes and donor spermatozoa, and three and two embryos were transferred respectively. The first recipient conceived a triplet pregnancy, while the second conceived a twin pregnancy. Both felt unable to cope with their multiple pregnancies and declined further counselling. Both were offered elective fetal reduction; however, both declined and both decided to terminate their pregnancies. Both patients underwent termination of pregnancy, despite being advised against it. The reasons couples may opt for termination of their much-wanted pregnancies, after a protracted period of infertility, intensive and expensive infertility treatment and despite the counselling they receive before, during and after their treatment, are discussed.
Asunto(s)
Aborto Inducido/psicología , Fertilización In Vitro , Embarazo Múltiple , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Donación de Oocito , Embarazo , Reducción de Embarazo Multifetal/psicología , Espermatozoides , Donantes de TejidosRESUMEN
OBJECTIVE: To compare the efficacy and tolerability of two recombinant human FSH (r-hFSH) preparations, follitropin-alpha (Gonal-F; Ares Serono, Geneva, Switzerland) and follitropin-beta (Puregon; Organon, Oss, the Netherlands), for superovulation in patients undergoing IVF-ET. DESIGN: Randomized, parallel-group, assessor-blind, single-center trial. SETTING: Outpatient tertiary referral center for assisted reproductive techniques. PATIENT(S): Forty-four infertile women undergoing IVF-ET. INTERVENTION(S): After down-regulation with buserelin acetate, patients were randomized to receive follitropin-alpha or follitropin-beta, 150 IU/d for 6 days; after that, dosages were adjusted according to the ovarian response. MAIN OUTCOME MEASURE(S): Cumulative dose of r-hFSH; duration of r-hFSH treatment; number of follicles of > or =11 mm and of 14 mm on day 7 of r-hFSH treatment and on the day of hCG administration; number of oocytes retrieved; number of viable embryos; and number of pregnancies (biochemical, ectopic, miscarried) and clinical pregnancies. RESULT(S): There were no statistically significant differences in any efficacy measures between the two preparations. The incidence of systemic adverse events was comparable in the two groups. Local reactions at the injection site were significantly more common and more severe with follitropin-beta than with follitropin-alpha CONCLUSION(S): Follitropin-alpha and follitropin-beta have comparable efficacy in patients undergoing IVF-ET.
Asunto(s)
Transferencia de Embrión , Fertilización In Vitro , Hormona Folículo Estimulante/uso terapéutico , Hormonas Glicoproteicas de Subunidad alfa/uso terapéutico , Adolescente , Adulto , Buserelina/uso terapéutico , Gonadotropina Coriónica/administración & dosificación , Femenino , Hormona Folículo Estimulante/administración & dosificación , Hormona Folículo Estimulante de Subunidad beta , Hormonas Glicoproteicas de Subunidad alfa/administración & dosificación , Humanos , Infertilidad Femenina/terapia , Embarazo , Proteínas Recombinantes/uso terapéuticoRESUMEN
OBJECTIVES: The aim was to evaluate whether women who have early follicular follicle-stimulating hormone (FSH) levels > 12 mIU/ml have reduced response to follicular stimulation for in vitro fertilization (IVF) in a following month, in spite of normal FSH levels. MATERIAL AND METHODS: In a 3-year period from January 1996 to December 1998, 303 women aged 38 years and above and/or who had previously responded poorly to superovulation for IVF gave blood samples for FSH, luteinizing hormone (LH), and estradiol (E2) on day 2 of menstruation before commencing treatment. RESULTS: In 117 (38.6%) of these women, FSH levels were > 12 mIU/ml (range 12-114 mIU/ml). Sixty-six of these women gave a further 130 blood samples for FSH measurement in the following months. Seventy-eight (60.0%) of the tests showed raised FSH value > 12 mIU/ml. Thirty women whose repeat FSH levels were < 12 mIU/ml underwent 41 IVF cycles (group 1). Sixty-three other women, older than 38 and/or who had a poor response to superovulation previously and whose FSH levels were < 12 mIU/ml, served as the control group (group II). There were no differences in the responses to superovulation and delivery rates between the two groups (14.6% vs. 12.7%). CONCLUSIONS: Women whose early follicular phase FSH levels were raised > 12 mIU/ml had an increased risk (> 50%) that in subsequent cycles levels would remain raised, and it was not possible to predict which individuals would have favorable FSH levels. If the cycle day 2 FSH level returns to a "normal" level of < 12 mIU/ml, women aged 40 and above had substantial cycle cancellation rates (43%), but patients who achieved the stage of embryo transfer had a good chance of conceiving, regardless of their age.
Asunto(s)
Fertilización In Vitro , Hormona Folículo Estimulante/sangre , Folículo Ovárico/fisiología , Inducción de la Ovulación , Adulto , Femenino , Hormona Folículo Estimulante/uso terapéutico , Humanos , Infertilidad Femenina/terapia , Embarazo , Resultado del Embarazo , Estudios ProspectivosRESUMEN
OBJECTIVE: To evaluate the place of cervical dilatation performed at the initial visit in an IVF-ET cycle in patients with known cervical stenosis. DESIGN: Retrospective study. SETTING: A tertiary care assisted conception unit. PATIENT(S): Fifty-seven patients who failed to conceive after a previous ET attempt and in whom the ET was classified as "difficult." INTERVENTION(S): Cervical dilatation under general anesthesia after pituitary suppression and before gonadotropin stimulation. MAIN OUTCOME MEASURE(S): Ease of the ET procedure and clinical pregnancy rate. RESULT(S): Eighteen (31.6%) of 57 women who failed to conceive after a previous attempt at IVF-ET achieved a clinical pregnancy after cervical dilatation. In 40 patients (70.2%), the subsequent ET was classified as "easy," whereas in the other 17 (29.8%), it remained difficult. The pregnancy rate was significantly higher when the ET was easy than when it was difficult (40% versus 11.8%, P<.05). CONCLUSION(S): In patients with cervical stenosis and a previous difficult ET, cervical dilatation during the initial visit leads to an easier subsequent ET and improves the pregnancy rate.
Asunto(s)
Transferencia de Embrión , Fertilización In Vitro , Primer Periodo del Trabajo de Parto , Enfermedades del Cuello del Útero/terapia , Adulto , Constricción Patológica , Femenino , Humanos , Embarazo , Índice de Embarazo , Retratamiento , Estudios RetrospectivosRESUMEN
PURPOSE: Our purpose was to investigate the effect of endometrial polyps on pregnancy outcome in an in vitro fertilization (IVF) program. METHODS: Endometrial polyps less than 2 cm in diameter were suspected by transvaginal ultrasound before oocyte recovery in 83 patients. Forty-nine women (Group I) had standard IVF-embryo transfer, while in 34 women (Group II) hysteroscopy and polypectomy were performed immediately following oocyte retrieval, the suitable embryos were all frozen, and the replacement cycle took place a few months later. RESULTS: Of the 32 hysteroscopies, a polyp was diagnosed in 24 cases (75%) and polypoid endometrium in another 5 patients (15.6%). An endometrial polyp was confirmed by histopathological examination in 14 women (58.3%). The pregnancy rate in group I was similar to the general pregnancy rate of our unit over the same period (22.4 vs 23.4%) but the miscarriage rate was higher (27.3 vs 10.7%, P = 0.08). In Group II, the pregnancy and miscarriage rates were similar to those of the frozen embryo cycles at Bourn Hall (30.4 and 14.3 vs 22.3 and 12.1%, respectively). CONCLUSIONS: Small endometrial polyps, less than 2 cm, do not decrease the pregnancy rate, but there is a trend toward increased pregnancy loss. A policy of oocyte retrieval, polypectomy, freezing the embryos, and replacing them in the future might increase the "take-home baby" rate.
Asunto(s)
Neoplasias Endometriales , Fertilización In Vitro , Pólipos , Complicaciones Neoplásicas del Embarazo , Adulto , Transferencia de Embrión , Neoplasias Endometriales/cirugía , Femenino , Humanos , Histeroscopía , Procedimientos Quirúrgicos Obstétricos , Pólipos/cirugía , Embarazo , Complicaciones Neoplásicas del Embarazo/cirugía , Resultado del Embarazo , Índice de Embarazo , Estudios RetrospectivosAsunto(s)
Transferencia de Embrión , Fertilización In Vitro , Resultado del Tratamiento , Femenino , Humanos , EmbarazoRESUMEN
The human ovary is a dynamic organ which continually changes in size and activity through life, as an integral part of the changes that the female is going through before during and after her reproductive life. Following the rapid increase in the use of transvaginal scan in recent years, the measurement of ovarian volume has become quick, accurate and cost-effective. Ovarian volume is an important tool in the screening, diagnosis and monitoring the treatment of conditions such as polycystic ovarian syndrome, ovarian cancer and adolescent abnormalities. In reproductive medicine, measurement of ovarian volume has a role in the assessment of ovarian reserve and prediction of response to superovulation.
Asunto(s)
Síndrome de Hiperestimulación Ovárica/diagnóstico por imagen , Neoplasias Ováricas/diagnóstico por imagen , Ovario/diagnóstico por imagen , Ovario/fisiología , Síndrome del Ovario Poliquístico/diagnóstico por imagen , Adolescente , Medicina del Adolescente/métodos , Adulto , Femenino , Fertilización In Vitro , Humanos , Persona de Mediana Edad , Síndrome de Hiperestimulación Ovárica/fisiopatología , Ovario/fisiopatología , Superovulación/fisiología , Ultrasonografía Doppler en ColorRESUMEN
Treatment with growth hormone-releasing factor (GRF) has been reported to improve the ovarian response to gonadotrophins in women who respond poorly to ovarian stimulation during in-vitro fertilization (IVF). The efficacy and tolerability of GRF were studied in a randomized, double-blind, placebo-controlled trial involving 196 patients. Following down-regulation with a gonadotrophin-releasing hormone agonist (GnRHa), patients were randomized to receive GRF (500 microg twice daily; n = 96) or placebo (n = 100) in addition to follicle stimulating hormone (FSH); treatment was continued until human chorionic gonadotrophin was given, or for a maximum of 14 days. GRF had no significant effect on the mean number of follicles with a diameter of >/=16 mm (GRF: 3.26 +/- 2.29; placebo: 3.27 +/- 2.30; P = 0.95), the number of FSH ampoules required to achieve ovarian stimulation (GRF: 55.2 +/- 16. 4; placebo: 54.9 +/- 17.2; P = 0.50), or on secondary measures of ovarian response and treatment outcome. There were, however, significant increases in circulating growth hormone (GH) and insulin-like growth factor (IGF)-1 concentrations. GRF was well tolerated. It is concluded that, despite producing significant increases in GH and IGF-1, concomitant treatment with GRF does not improve the ovarian response to FSH in poorly responsive women undergoing IVF.